Healthcare. Politics. Family.

Value-Based Purchasing Presents Challenges to Teaching Hospitals

Published in the January 2012 Association of American Medical Colleges Reporter

By Whitney L.J. Howell

Starting October 2012, hospitals will be paid under a new Centers for Medicare and Medicaid Services (CMS) program that ties a percentage of their Medicare reimbursement to performance on a set of quality metrics, including patient satisfaction. Called a value-based purchasing (VBP) program, it is one of three new performance-based payment programs under the Affordable Care Act. The other two payment programs focus on performance related to readmissions and hospital-acquired conditions.

Performing well under VBP will be both a challenge and a financial necessity for teaching hospitals. “It’s a fundamental responsibility of all physicians in all academic medical centers to deliver high-quality, cutting-edge care,” said David Longworth, M.D., chair of the Cleveland Clinic’s Medicine Institute. “Now, we’re being asked to find a way to increase the value of services while cutting costs. It will be challenging, but it’s imperative for our economic survival.”

The VBP program will combine a hospital’s score on a patient satisfaction survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), with the facility’s success on 12 process-of-care measures in areas such as heart failure, pneumonia, and health care-associated infections. Poor performance on these measures can mean a reduction in reimbursement—when providers and facilities are already fighting to retain their payments.

Teaching hospitals continue to have concerns over how the program is structured, specifically the current emphasis on the HCAHPS survey. While patient satisfaction is a critical component to quality of care, recent research has shown that a sicker patient population could lead to lower scores and ultimately affect how teaching hospitals will fare under the new program.

“Value-based purchasing will be a real challenge for academic medical centers because they have the most difficult patient population,” said Robert Berenson, M.D., an internist and health care policy expert with the Urban Institute, a nonpartisan commission that analyzes public policy issues. “There is a concern that these facilities will not look like they are doing as well as community hospitals because they often provide more complex care to patients who are already more likely to have a negative outcome.”

However, many teaching hospitals have been incorporating quality-improvement strategies to prepare for the new payment program.

The Cleveland Clinic is using a number of strategies to improve its HCAHPS scores; however, Longworth emphasized that true differences in quality performance start with medical education.

“We’re embedding value by introducing medical students and residents to quality measures and outcomes,” he said. “This way they understand from the beginning that it is our moral imperative as health care professionals to do what we can to improve care quality.”

In 2010, the Cleveland Clinic held a Patient Experience Summit, dedicated to discussing patient quality of care and best practices.

New York-Presbyterian Hospital has several strategies in place, according to Eliot Lazar, M.D., senior vice president and chief quality and patient safety officer. The goal, he said, is to ensure that hospital employees understand the overall importance of quality and patient safety.

“It’s extremely important that our staff understand how to provide the highest-quality care whether it’s based on value-based purchasing or the Joint Commission,” Lazar said. “We make a point of integrating value-based goals with recommendations from our own experiences and national patient safety standards to create a cohesive quality and cost-controlling curricula.”

Residents from the hospital’s affiliated medical schools—Weill Cornell Medical College and Columbia University College of Physicians and Surgeons—have formed Housestaff Quality Councils (HQCs) to give administrators feedback about issues or problems they see at the front lines of patient care. Representatives from all departments meet monthly to craft solutions to common issues that will be easy to implement. For example, the Weill Cornell HQC improved the hospital’s medication reconciliation program by recommending that the electronic health record (EHR) prompt residents to perform a medication reconciliation within six hours of an admission. The EHR also prohibits further orders if the reconciliation is not completed within 18 hours.

“These councils are an excellent way for us to hear from residents who are out there with the patients,” Lazar said. “There are many times when we seek advice from the councils.”

“With less than a year left to gear up for VBP, the AAMC is fully committed to helping its member institutions identify the best strategies that will help them meet the quality-improvement and cost-reduction requirements,” said Jennifer Faerberg, AAMC director of health care affairs.

“We are working with institutions that have taken steps to make VBP implementation easier,” she said. “We are developing a forum for institutions to share their best practices. We cannot change the institutional structure or the patient dynamics, but we can help members do the best they can with what they have.”

Excellent article with great quotes and unique details. I was moved by the “moral imperative” statement and I smiled when I read “the Urban Institute, a nonpartisan commission.”

I was lead to your informative article by a Google Alert for HCAHPS:

Web 1 new result for HCAHPS
HCAHPS « Whitney Howell
Teaching hospitals continue to have concerns over how the program is structured , specifically the current emphasis on the HCAHPS survey. While patient …
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I am surprised that I have not yet received a Google Alert linking me to your original publication at AAMC.

Who am I?

I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C.

I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.